MEDICARE: GREENVILLE-PEDIATRICS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	14106	SC

General Provider Information

NPI Number	:	1720102809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE-PEDIATRICS PA

Provider Business Mailing Address
First Line	:	37 BRENDAN WAY
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3514
Country	:	US
Telephone Number	:	864-458-7792
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 BRENDAN WAY
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3514
Country	:	US
Telephone Number	:	864-458-7792
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN HARVEY WASHBURN
Credential	:	M.D.
Telephone Number	:	864-458-7792

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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